Zappella Nathalie, Merceron Sybille, Nifle Chantal, Hilly-Ginoux Julia, Bruneel Fabrice, Troché Gilles, Cordoliani Yves-Sebastien, Bedos Jean-Pierre, Pico Fernando, Legriel Stephane
Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, 78150, Le Chesnay, France,
Neurocrit Care. 2014 Jun;20(3):494-501. doi: 10.1007/s12028-014-9962-2.
Stroke due to occlusion of the artery of Percheron (AOP), an uncommon anatomic variant supplying the bilateral medial thalami, may raise diagnostic challenges and cause life-threatening symptoms. Our objective here was to detail the features and outcomes in three patients who required intensive care unit (ICU) admission and to review the relevant literature.
Description of three cases and literature review based on a 1973-2013 PubMed search.
Three patients were admitted to our ICU with sudden-onset coma and respiratory and cardiovascular dysfunctions requiring endotracheal mechanical ventilation. Focal neurological deficits, ophthalmological signs (abnormal light reflexes and/or ocular motility and/or ptosis), and neuropsychological abnormalities were variably combined. Initial CT scan was normal. Cerebral MRI demonstrated bilateral paramedian thalamic infarction, with extension to the cerebral peduncles in two patients. Consciousness improved rapidly and time to extubation was 1-4 days. All three patients were discharged alive from the hospital and two had good 1-year functional outcomes. Similar clinical features and outcomes were recorded in the 117 patients identified in the literature, of whom ten required ICU admission.
Bilateral paramedian thalamic stroke due to AOP occlusion can be life threatening. The early diagnosis relies on MRI with magnetic resonance angiography. Recovery of consciousness is usually rapid and mortality is low, warranting full-code ICU management.
大脑后动脉丘脑穿通动脉（AOP）闭塞所致的卒中是一种供应双侧内侧丘脑的罕见解剖变异，可能会带来诊断挑战并引发危及生命的症状。我们在此的目的是详细阐述三名需要入住重症监护病房（ICU）的患者的特征及预后情况，并对相关文献进行回顾。
描述三例病例并基于1973 - 2013年PubMed检索进行文献回顾。
三名患者因突发昏迷以及呼吸和心血管功能障碍入住我们的ICU，需要进行气管内机械通气。局灶性神经功能缺损、眼科体征（异常光反射和/或眼球运动和/或上睑下垂）以及神经心理异常情况各不相同地组合出现。初次CT扫描正常。脑部MRI显示双侧丘脑旁正中梗死，两名患者的梗死灶延伸至大脑脚。意识迅速改善，拔管时间为1 - 4天。所有三名患者均出院存活，两名患者1年功能预后良好。文献中确定的117名患者也记录了类似的临床特征和预后情况，其中10名需要入住ICU。
AOP闭塞所致的双侧丘脑旁正中卒中可能危及生命。早期诊断依赖于磁共振血管造影的MRI检查。意识恢复通常迅速，死亡率低，因此值得在ICU进行全力救治。
